And state Sen. Pete Brungardt, R-Salina, said he didn’t understand Brownback’s decision to return a $31.5 million federal grant to build a health insurance exchange under the Affordable Care Act, or ACA.

Several Republicans, however, rallied to Colyer’s support as he stood before the House-Senate Health Policy Oversight Committee for nearly two hours talking about two major health care issues facing Kansas: increasing costs of Medicaid, and changes to the insurance landscape that will come under the ACA.

Colyer said the state must get control of Medicaid costs, which he said have increased 400 percent in the past 20 years.

“The current costs are going to overwhelm Kansas,” he said.

Colyer did not reveal what the Brownback administration would recommended to the Legislature, but he said many states were heading toward a managed care system for Medicaid with coordinators assigned to take care of patients with the highest medical needs.

Reitz said if the state tried to cut Medicaid services, “We are going to have people marching on the Statehouse, tearing this place apart.” Colyer said he did not want to cut “people that need our care.”

As far as coordinators, Reitz, a physician, said that’s what doctors were paid to do. “I don’t think these are new ideas and they’re not saving any money,” Reitz said to Colyer.

Colyer also outlined the reasons Brownback rejected the $31.5 million grant, which the governor had earlier supported. The “early innovator” grant was to be used to implement a health insurance exchange, which would be a one-stop market for hundreds of thousands of Kansans to purchase coverage and receive subsidies if they qualified. It is required under the ACA to be in place by 2014.

Colyer said the Brownback administration would not implement the exchange until the U.S. Supreme Court had decided whether the ACA was constitutional. “Obamacare was not popular in the state of Kansas,” Colyer said.

But Brungardt said rejecting the federal grant “seemed like a huge opportunity to take a pass on.” He said he didn’t understand the philosophy of refusing to deal with the ACA until case law was settled. If states simply ignored federal laws, he said, “We’d have a banana republic here of gigantic proportions instead of the United States of America."

Colyer said there were too many federal strings attached to the grant and too many regulations. He showed a book to the committee that he said contained 200 pages of proposed regulations for the exchange, including numerous requirements of employers.

And he said that under the exchange the federal government would determine whether treatments were inappropriate or too costly in end-of-life areas. “That troubles me greatly,” he said.

State Rep. Peggy Mast, R-Emporia, said she agreed with the steps the Brownback administraiton had taken.